# DANA M. COSTELLO, PEDIATRIC PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467787101
- **Authorized official:** DR. DANA M. COSTELLO (OWNER)
- **Authorized official phone:** (973) 204-3491

## Contact information

- **Practice address:** 501 JULIE CT, WYCKOFF, NJ 07481-1100
- **Practice address phone:** (973) 204-3491
- **Practice address fax:** (201) 891-1344
- **Mailing address:** 501 JULIE CT, WYCKOFF, NJ 07481-1100
- **Mailing address phone:** (973) 204-3491
- **Mailing address fax:** (201) 891-1344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 40QA00907700 | NJ | Yes |

## Other

- **Enumeration date:** 10/14/2009
- **Last updated:** 10/14/2009